Provider Demographics
NPI:1922007434
Name:SOLLARS, CANDIS KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CANDIS
Middle Name:KAY
Last Name:SOLLARS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 12TH ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4146
Mailing Address - Country:US
Mailing Address - Phone:503-325-3623
Mailing Address - Fax:503-325-4986
Practice Address - Street 1:1 12TH ST
Practice Address - Street 2:SUITE #4
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4146
Practice Address - Country:US
Practice Address - Phone:503-325-3623
Practice Address - Fax:503-325-4986
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000000000053OtherBLUE CROSS BLUE SHIELD
ORA023OtherTRIWEST
OR0000000000053OtherBLUE CROSS BLUE SHIELD